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[2] Rockwood,

et al.

(2005). Fit for Frailty: Consensus best practice

guidance for the care of older people living with frailty in

community and outpatient settings. British Geriatric Society



Is cognitive frailty

functional sarcopenia


D. Wilson, T.A. Jackson, E. Sapey, J. Lord.

Institute of Inflammation and

Ageing, University of Birmingham


Sarcopenia is defined as low muscle mass (LMM) and

low muscle strength (LMS) or poor physical performance (PPP);

with low muscle mass being considered a pre-requisite and severe

sarcopenia present when all three parameters are positive. Cognitive

frailty is the presence of both physical frailty and mild cogni-

tive impairment (without dementia). We hypothesised that cognitive

frailty would impact on physical performance, causing a state of

functional sarcopenia



Muscle mass (bilateral quadriceps ultrasound), muscle

strength (hand grip strength), physical performance (timed 4

metre walk), and cognitive impairment (Addenbrooks Cognitive

Examination) were documented in 33 highly characterised >65 yr

olds. Participants were divided into four groups: normal muscle mass

(NMM) and normal cognitive function(NCF)(n = 11), NMM and

cognitive impairment(CI)(n = 4), Low muscle mass (LMM) with NCF

(n = 11), LMM and CI(n = 7).


NMM and CI and LMM and CI had similarly poor physical

performance outcomes (number of falls, distance walked out-

side, short physical performance battery) while NMM with NCF and

LMM with NCF had similarly high scores across all these performance

outcomes. For example mean distance walked; NMM + CI = 88 m +

43; LMM + CI = 91 m + 44; NMM + NCF = 7455 m + 981; LMM + NCF =

7918 + 1004. Differences could not be explained by age.


Mild cognitive impairment is associated with poor

physical performance, causing a state of

functional sarcopenia

in the

absence of low muscle mass. The mechanism linking these conditions

is unclear but inflammageing can impact both on muscle strength and

cognitive ability. Ultimately this may provide a pathway to severe



Ultrasound echogenicity is a better predictor of strength and speed

than age

D. Wilson, T.A. Jackson, E. Sapey, J. Lord.

Institute of Inflammation and

Ageing, University of Birmingham


Muscle quality is increasingly recognised as impor-

tant as muscle size in sarcopenia. Ultrasound echogenicity, reported

as a grey-scale value (GSV), is significantly associated with intramus-

cular adipose tissue [1]. We hypothesised that muscle quality (grey-

scale value) would be an important tool to diagnose sarcopenic



Participants were recruited to three groups: healthy

younger adult s(HY < 35 yrs; n = 16), healthy older adults (HE >65 yrs,

no chronic inflammatory diseases, n = 9) and frail older adults

(FE >65yrs, positive Frailty Index, n = 6) [2]. Participants were

extensively clinically characterised including bilateral ultrasound

image capture of the thigh using an established protocol [3].


The three groups had significantly different GSV (HY-

57.5 + 3.7; HE-54.2 + 8.7; FE-41.2 + 6.4; p = 0.037) with the FE group

being significantly lower than the HY group (p = 0.029). The GSV

correlates with adjusted hand grip strength significantly (R =


p = 0.002) and adjusted walk speed (R =

0.374, p = 0.055) when

controlling for age. This correlation is far stronger than the correlation

of adjusted muscle depth with adjusted hand grip strength (R = 0.003,

p = 0.986) and adjusted walk speed (R = 0.02, p = 0.944) when con-

trolling for age. GSV do not correlate with BMI or adjusted subcuta-

neous tissue depth (BMI r -124, p = 0.5; adjusted subcutaneous tissue

depth r 0.031, p = 0.867).


We have demonstrated that ultrasound echogencity is a

predictor of strength and speed when controlling for age. It is also a

better predictor than muscle size. Intramuscular adipose tissue is

neither related to BMI nor adjusted subcutaneous tissue depth.

These data suggest an assessment of sarcopenia should include a

measure of intramuscular adipose tissue. Further studies will be

needed to confirm this finding.


1. Reimers

et al.

, 1993.

2. Mitnitski

et al.

, 2001.

3. Strasser

et al.

, 2013.


Associations between frailty and no prescription of anticoagulant

therapy among older inpatients

Y. Yamada, T. Kojima, Y. Umeda-Kameyama, S. Ogawa, M. Eto,

M. Akishita.

Department of Geriatric Medicine, University of Tokyo,

Graduate School of Medicine

Background and Purpose:

Preventing embolic cerebral infarction is

important since it decreases activity of daily living and quality of life

in old people. However, appropriate use of anticoagulants is difficult

in frail old people because of increasing risk of bleeding events. Thus

the present study examined the association between no prescription

of anticoagulant therapy and frailty in older inpatients.


835 patients aged

65 who were admitted to the geriatric

ward of The University of Tokyo Hospital between 2013 and 2015 were

enrolled. 100 patients (men 48%, mean age 84.4 ± 7.4 years) had atrial

fibrillation. Comprehensive geriatric assessment was performed and

frailty was evaluated by BMI, IADL scale and Barthel index, MMSE,

vitality index, GDS15, and by living alone or not.


Among them, 44% were taking anticoagulant therapy. On

univariate analysis, higher age, lower body mass index, vitality index,

IADL and Barthel index were significantly associated with no prescrip-

tion of anticoagulant therapy. On multiple logistic regression analysis,

older age and higher BMI were associated with no prescription of

anticoagulant therapy, independent of other factors that were signi-

ficantly associated in univariate analysis.


In older inpatients with atrial fibrillation, lower BMI, a

component of physical frailty was associated with no prescription of

anticoagulant therapy. Further studies are needed to clarify the

medical appropriateness of prescription of anticoagulant therapy.


Feasibility of general medicine to make an assessment of frailty in

patients who are over 65 years old. Regarding a prospective study

over a three-month period.

A.A. Zulfiqar


, A. Martin-Kleisch


, A. El Adli


, R. Vannobel


, C. Lukas



M. Dramé




Department of Internal Medicine-Geriatrics-Therapeutics,

University Hospital of Rouen, Rouen,


Department of General Practioner,

University Hospital of Reims,


Department of Emergency Care Unit,

University Hospital of Reims,


Research and Innovation Unit, University

Hospital of Reims, Reims, France

Our aimwas to find out if SEGA/Fried scores were applicable to general

medicine. Prospective study carried out. For each patient and before

calculating frailty scores, the general practitioner and the intern

assessed the presence, or not, of frailty and of the quality of aging. 38

patients were included. The average age is 78.3 years. The average

Fried score is 1.9. As concerns frailty, according to SEGA, the non-frail

represent 17 patients (44.7%), the pre-frail are 4 patients (10.5%) and

the frail 17 patients (44.7%). According to Fried, the non-frail account

for 9 patients (23.7%), the pre-frail in 17 patients (44.7%) and the frail in

12 patients (31.6%). For the concurrence of Doctor vs. SEGA and Doctor

vs. Fried, the assessment of the concurrence shows an excellent

agreement (Kappa = 0.8924) in relation to the SEGA score, whereas

this agreement is moderatewith Fried

s score (Kappa = 0.4627). For the

concurrence Intern vs. SEGA and Intern vs. Fried, we find once again an

Poster presentations / European Geriatric Medicine 7S1 (2016) S29